Referring Provider Field Descriptions

This referrer is an: Select the referring providers type. For example, choose Individual (Type 1) if the referring provider is a person and choose Organization (Type 2) if the referring provider is a place.

Referring Type: Select the referring providers' type. By default, Referring Provider is selected, however, select Primary Care Provider if the referring provider is the patient's assigned physician that provides primary care and acts as the gatekeeper that controls access to other medical services.

Do not send referrer on claims: Check this box to include or not include this referring Provider on claims.

NPI: The referring provider’s NPI number.

Taxonomy Specialty: The referring provider’s Taxonomy code that identifies the provider type and area of specialization.

Sequence#: This number is auto-populated by CollaborateMD. This field is informational and does not appear on the claim.

Reference#: In the event, you have to enter a referring provider into the system twice, use this field to help distinguish between the two providers. (i.e. TAX ID, EIN, Provider A, Provider B). This field is informational and does not appear on the claim.

Address: The referring provider’s address information.

City: The referring provider’s city.

State: The referring provider’s state.

Zip Code: The referring provider’s zip code.

Phone #: The referring provider’s phone number.

Fax #: The referring provider’s fax number.

Home Phone #: The referring provider’s home number.

Cell Phone #: The referring provider’s cell phone number.

Email: The referring provider’s email address.

Pager #: The referring provider’s pager number.

Tax ID: The referring provider Tax ID number.

Tax ID Type: Define whether the provided Tax ID number is an SSN or a TIN number.

UPIN: Medicare assigned number to identify providers. This number populates to box 17a on the CMS-1500 form.

BCBS ID: Bluecross Blueshield assigned number is used to identify providers on professional paper claims:

This value is put into box 17a with a G2 qualifier when sending to a payer type of either Blue Cross Blue Shield or Blue Cross.

Printing of referring providers. This value is included in the printout when printing from the Referring section.

Champus ID: Tricare assigned number is used to identify providers on professional paper claims:

This value is put into box 17a with a G2 qualifier when sending to a payer type of Tricare/Champus.

Printing of referring providers. This value is included in the printout when printing from the Referring section.